Revenue Recovery And Compliance Tips For The Out-Of-Network Provider

Revenue Recovery and Compliance are two of the most important business operations at a health care provider’s facility. Unfortunately, they can also take up a lot of your staff’s time and resources. We’ve compiled a list of helpful practices to help reduce costly mistakes, and improve efficiency.

Recovering Lost Revenue

Many healthcare providers are faced with the uphill battle of recovering payments for services they provided. These delayed or lost payments can add up quickly and become a drain on your staff.

Here are a few tips that can help you increase your health care facility’s bottom line:

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Gather proof of submission and receipt of claim:

All too often, insurers will deny or delay reimbursements to health care providers because of incomplete or missing claims. A call to the health insurer will be met with the infamous “No Claim on File”.

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To hold insurers accountable, ensure you have:

A copy of the claim

Proof of submission

A receipt of the claim

- If the claim is submitted electronically, your clearinghouse can give you access to a report verifying that claims were received by the health plan. Simply send this proof to the health plan representative who tells you there is no claim on file.

- If claims or appeals are filed on paper, send them by certified mail, return receipt requested. You should at all times try to send claims electronically as these claims will be processed quicker and you will receive faster claim payments.

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Identify accounts that are least likely to pay:

Should be quickly appealed

Ensure that your patients
agree in writing to be responsible ultimately for the charge, uncovered
services, pre-certification and referral requirements

Have patients sign an
Enforceable Assignment of Benefits form

- AOB forms not only assign a claim benefit or payment to the practice, but assign other rights to the provider and their representative such as the right to file claims, appeal and even to litigate against the health plan.

- All appeals should include an enforceable AOB signed by the patient.

Determine the exact reason
why the insurer believes they are entitled to recoupments

Ensure you make an ERISA
Demand, requesting the insurer’s entire investigative file

Hire an attorney with
experience in out-of-network investigations and health plan recoupment defense

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How The Patriot Group Can Help

The Patriot Group and their Law Firm, The Force Law Firm, PC., are managed by highly trained attorneys with experience in the area of Appeals, Revenue Recovery Techniques and Recoupment Defense. They provide the highest quality of revenue recovery and compliance services for healthcare community by advocating and fighting for the rights of its healthcare physician facility clients and their patients with the various insurance companies.

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